Translating social neuroscience to help children raise parents they can live with and they're crazy about~

The Cost of the Cut: Reflections on Infant Circumcision

I remember the day after my first child was born. A well-known “OB to the Stars” in New York City who delivered my son came in to see what we wanted to do about circumcision. “This is completely up to you,” she said with authority. “But it only takes a minute and he won’t remember a thing. I do it myself. It is absolutely not a big deal.” I trusted her judgment in a New York nanosecond as I had trusted her throughout the labor. She was beyond confident. I, on the other hand, was 27 years old and quite without confidence. I was unprepared for mothering and comforted by the idea that the medical establishment had the answers. Still, I had the good sense to turn to my husband, saying simply, “This is up to you.” Nick declined the procedure for Michael, and later for Peter and Gil, our two twin boys even though, or perhaps because, he himself had been circumcised at birth.

Later on, I was surprised to discover the emotions our choice triggered in my father. Not having been circumcised after his home birth on an Iowa farm, he had it done in the Navy and found it a brutal experience, one he did not want his grandchild to go through. “Best to just get it over and done with early,” he said, never questioning the ultimate need for it, the timing of doing it with a newborn, the humanity of the procedure itself or its ultimate side effects on body or psyche. Dad’s conclusion that it would never be remembered still seems to be the norm in America. Though circumcision rates in the United States have declined from 90% to 57% in the past 40 years, it is still much more common here than in Europe, Australia or Canada where rates are usually well under 20%.

Traumatic Learning

Because of this pervasive lack of public dialogue on this subject, it was probably fifteen years before I discovered literature on trauma while I was studying and practicing body psychotherapy. I learned that, far from never remembering traumas of this nature, a baby’s nervous system registers events such as birth, early bonding and circumcision with a strong neural imprint. In these imprints are messages about the safety and kindness of the world that often lasts a lifetime. Further, I began to notice that circumcision was an experience that exerted a significant influence on the psyches of my male clients. It was certainly far from the innocuous, small procedure, assumed forgotten, I had been assured about after Michael’s birth. I began to ask myself: “Where had my OB’s authoritative certainty that it would be ‘no big deal’ to my baby come from?” It certainly did not appear to come from sound medical or psychological research.

The idea that babies and children are not significantly influenced by harsh experiences because they do not have conscious recall of them later, is the greatest distortion of truth I have had to witness as a doula, therapist and mother, one that seems to live on in hospitals and within medical personnel despite their often very good conscious intentions. It is an idea that should, in my opinion, be challenged loudly and at every possible opportunity by many voices, good research and common sense.

Rachel’s Story

Challenging such thinking is just what my friend Rachel did a couple of years ago, however it was not without a price. As a new nurse on a labor and delivery floor in a large New York City hospital, Rachel was given circumcision support duty as one of her first assignments. She had no idea where this duty would take her. When I talked with her after her first few months she was visibly distraught by her job and the suffering she was witnessing. She also worried that she might lose her job for complaining loudly and often about something that seemed unnecessarily cruel. The circumcisions Rachel was assisting were generally administered with no anesthesia to babies. This is a traditional practice still in common use despite the fact that the American Association of Pediatrics does not consider circumcision medically necessary and has advocatedfor the use of anesthesia since 1999. (A compelling, but graphic description of what Rachel was witnessing can be read in this description offered by then nursing student, Marilyn Milos who eventually founded NOCIRC).

Being naturally empathic, Rachel’s experience of the agony of infants during this procedure was nearly more than her nervous system could bear. She was forthright in her complaints to doctors about not using the anesthesia, and assertive in requesting that they follow APA recommendations. She even counseled parents to request the anesthesia, and advised them this would probably not happen without their active intervention (a practice that did not make her popular with colleagues). Indeed, she once witnessed a doctor blatantly ignore a parent’s request for local anesthesia for their child’s circumcision (don’t, and say you did!), unilaterally deciding that it was unnecessary. I am sure that Rachel’s empathic presence helped many babies she comforted post-operatively, but the toll this compassion took on her own mind and body was extreme. Being new, young and not yet numb to the experience of suffering before her, her own nervous system was at risk. She began to lose both weight and hair as symptoms of what is now recognized as “vicarious trauma.”

Awakening Direct Awareness

I am not saying here that it is necessarily unethical to circumcise infants or intending in any way to impose guilt about choices families make. Certainly if my husband had answered, “Yes, please, let’s have the circumcision,” I would have complied without thought and would have known little about my child’s experience. Circumcision is a world-wide, cross-cultural practice often associated with the initiation of males and religious rites. It has been around a long time and is likely to be with us for a long time to come. There are undoubtedly arguments in its favor that must be weighed. However, there seems to be ample and growing evidence from places like Circumcision Information and Resource Pages http://www.cirp.org/, the National Organization of Circumcision Information Resource Centers http://www.nocirc.org/, or advocacy organizations such as Intact America www.intactamerica.org that circumcision as we often do it, is an unnecessary surgery which is significantly traumatizing to infants and may be associated with later sexual problems such as impotence, premature ejaculation, and erection dysfunction. Advocates often note the ethical problem of permanently disfiguring the body of someone else without their consent. Perhaps most importantly, most circumcisions happen without loving parents present to comfort and reassure the baby, and often without the basic courtesy of anesthesia that any one of us would demand if the most delicate part of our body was to be ritually modified.

I recall Mark’s “Big Brain Question” here. A newborn getting a circumcision alone with strangers has got to be screaming, “Are you there for me?!” and “What kind of painful world is this!?,” and not getting very good answers. At least that is what Rachel and other witnesses to live circumcisions tell me (even with anesthesia). Surely if we can put newborns through it, we should be willing to go through such an initiation ourselves, even if only as witnesses and empaths. I have a feeling that directly observing this experience might change a lot of our unexamined views on the subject.

Any man who has not been circumcised knows of the sensitivity of the glans and how the skin protects that sensitivity. Mutliating this protective cover at birth is barbaric and inhuman. My wife was approached at the hospital when both my sons were born and one nurse actually made her feel ‘guilty’ for not having our sons circumcised. It amazes me how some people in the medical establishment still views this act as ‘no big deal’. I’m glad my wife was not swayed.

Years ago, my next door neighbor and I happened to both get young Doberman puppies within two weeks of each other. They were great friends through the chain-link fence that separated our yards. I made friends with the puppy next door too, of course.

One day, the neighbor puppy came to the fence with his ears clipped and bandaged. The neighbors had decided he needed the proper Doberman stand-up ears, which required cutting and splinting them. As he had every day since we’d known him, the puppy turned his head and rubbed it against the fence, telling us he wished to be scratched behind the ears. OUCH!!

Every time he “told” us he wanted affection, he would start yelping in pain, poor guy. I tried to help him learn another way of greeting us with no success. Instead he soon learned that we were not friends after all. He had been conditioned to understand that we were the cause of pain.

A few short years later I was at my sister’s house while she took care of her newborn boy. It was diaper changing time and, as infants do, he was delighted to be naked and chortled with glee. He and my sister had a fun time playing while she removed the soiled diaper and cleaned him up.

Then right before putting the clean diaper on, she took a cotton swab soaked with alcohol and dabbed at my nephew’s circumcision scar – as directed by her doctor, to avoid infection. He shrieked, then howled in shock and pain. Of course! She repeated the line, learned from the medical folks, about him not remembering later.

I was reminded of my neighbor’s dog, and Pavlov’s dogs, and subsequent research on conditioned learning. I couldn’t help but wonder if some of the anger and hostility we see in society stems from associating one’s penis with pain from some of the earliest experiences of one’s life.

In addition to its association with the penis, “care” such as my sister gave would be deeply, pre-verbally connected with the person to whom the baby is most closely bonded, and on whom the baby relies for its survival needs. In my nephew’s case, it also immediately followed playful fun and genital touch.

So the infant could learn any of a number of “valuable” lessons (just like my neighbor’s puppy did): Pleasure leads to pain; whenever the genitals are touched, pain could follow; You can’t trust the one you love the most (or the one you rely on the most); etc.

There might be simpler solutions to some of society’s ills than we suspect. Eliminating circumcision in those too young to choose it and understand it is one of those simple solutions.

Thank you to all of you working to change the ignorance around this. You’re changing more than is visible on the surface.

This is an excellent piece. Thank you! We elected not to circumcise our little boy a couple of years ago. Aside from my intellectual understanding about trauma, I had my own bit of anecdotal evidence of the “unthought known” to rely upon in my discernment process. I vividly recall horrific dreams when I was very young where I would awaken in terror after seeing my own penis and hands soaked in sticky, warm blood. I was always relieved to find myself “safe” and “unharmed” when I awoke, but the images haunt me to this day. Thus, the decision was ultimately not a very difficult one for my wife and me, but I was shocked at the arguments I had to face, not only from my own father (who offered a collection of spurious arguments that were all covered in various posts here), but also from physicians, including a pediatric urologist at Stanford! The myths are terribly pervasive and persistent in the culture and in the medical establishment. The truth is, the “science” that supports this barbarism is poorly conceived and makes overreaching and terribly misleading claims. And now the medical industry is trying to make the case that circumcision is a valuable intervention in AIDS prevention! It’s outrageous.

I circumsized my oldest because i really didn’t know better and believed all those damn myths out there. Well, he end up having some bad reattachement issues. So, i finally started looking into circumsion and was amazed at what i found. I was amazed that no health orginization recommends routine circumsion and that my sons problem was NOT that rare. My youngest son is NOT circumsized. YEs, their penis’s will look slightly different. God forbid if i have to TALK to my children and explain that people are DIFFERENT and that I(an imperfect person) made a mistake, but learned from it
Delete

I let my pediatrician husband decide about our son’s circumcision, and I believe he chose it because he wanted our baby to look like his daddy when he grew up. But I knew Robert shouldn’t go through it alone. I had to talk a long time in order to be present for his circumcision, and I believe I only won because I was a doctor’s wife and a hospital chaplain, and assured them I would not become a patient myself. I stood at Robert’s head and put my cheek against his and said “Little one, I am so sorry. Let this be a sign of a covenant with God for you.” I have hoped that my presence and support would help him through all the hard times of his life. These days he is pretty sure God abandoned the covenant…..

Thank you so much for this piece! Your help in getting the word out and sharing your personal experience is greatly appreciated. Just this week, the New York Times ran a piece about this issue, and how the Center for Disease Control is actually considering recommending circumcision for all US infant boys. We at Intact America are in Atlanta right now, at the CDC’s HIV conference, to remind them that circumcision does not prevent HIV.

Again, thank you and your readers for your support. If anyone would like more information, you can visit us at http://www.intactamerica.org — links to the NYTimes article, a piece that aired on MSNBC yesterday, a petition to the CDC, and more.

Great great great article. I can’t tell you how much I appreciate people who take time to fight against unnecessary infant circumcision. We need to spread the word that circumcision is not recommended and is not routine, and that there is trauma associated with the procedure. We must tell our friends that our boys will not feel different than their peers. For those moms/dads who are adamant, let them know that they must demand a pain blocker (although even that doesn’t necessarily do the job, and has risks!).

We are in a bad time. Studies are coming out “proving” that cutting is helping prevent sexually-transmitted diseases. We must stand up for the rights of the newborn – to prevent the trauma of this barbaric practice. Please find your local chapter of NoCirc.org and see what you can do to help spread the word.

I was the second victim of this practice in my family (Dad circumcised but uncles were not and none of my grandfathers were) back when doctors didn’t even ask permission. It was another $5.00 on the bill for my delivery. I am so happy about it, I would like to offer the doctor who did me a return favor and circumcise him just below his chin. Fortunately for both of us, he is now long dead!

I first learned of this violation of my body in the most personal and private way possible at the most vulnerable time in my life when I saw a classmate’s intact penis in second grade. I assumed that boys were like puppies and some have erect ears and some have floppy ears but I wanted the kind he had. I was just in puberty when I learned what had really happened and assumed it was some kind of punishment foisted on me.

I joined the movement against this violation when I learned of the movement about 10 years ago and will fight it until my death. There are already hundreds of boys that have been spared this insult to their bodies as a result of my work and I fully expect that number to ultimately number in the millions. I consider that a life well lived and with a purpose valuable to mankind.

Jeanne, Thanks for this great article. Back in the 80’s I had the good luck to attend a childbirth class taught by a strong advocate against circumcision. I also spoke with my OB and it was his opinion the primary benefit of circumcision was to keep young interns in grocery money, as they are often the ones doing the procedures. It was a radical choice back then and I have never regretted my decision to refuse this unnecessary surgery for my children. Now, as a psychotherapist specialized in anxiety reduction and trained in Somatic Experiencing, an elegant modality for releasing trauma from the body and mind, I am even more sure of this long ago decision. Interestingly enough, although pre-verbal trauma and surgeries has been a very significant part of my training, we did not specifically speak of circumcision, which has had an impact on so many men and boys over the years. I’ll be adding this question to my intake assessment in the future. Thank you for reminding me of this important and devastating practice. Your article will be a great resource for my clients.

Thank goodness we decided not to circumcise my son. It helped that he was born at a birth center with a midwife that did not offer it. This is another reason in my mind that we need to get births out of hospitals and back with midwifes. I feel bad for all these boys that are being mutilated to “fit” in.

Well said. As a Childbirth Educator this is a topic of conversation quite often in my classes and I do appreciate how many more people are putting thought into this choice. It is not my place to put my belief system on people, but I do try to empower parents to follow their own hearts. And I try to get them to see this little unborn baby inside of them as a human being with thoughts and feelings and emotions all of their own. I also make two very specific recommendations when it comes to circumcision…that they must insist their son get anesthesia and they must insist that one or both parents are allowed to be present during the procedure.

My oldest son is circumcised because I thought that was just what you did at the time. My 2nd son is not. Can I trace back their significantly different nervous system behaviors to circumcision? I don’t have an absolute answer to that, but my research and my studies and my mothering instinct tells me that, in some part, I can. They are both intelligent, creative, amazing children. Nonetheless, there has always been a marked difference in their ability to handle stress and sickness. And I often wonder about the stress and trauma that was put upon my oldest son when he was less than 24 hours old and how that experience helped form the human being he became. I could go on about this forever, but I’m preaching to the choir. 🙂

I am so glad to learn there are people working on this issue! When my son was born in 1962, I felt clearly that it was a bad idea and unnecessarily cruel, but the nurses said “You don’t want him to feel different from the other boys and embarrassed about that.” That argument swayed me, and I allowed the procedure to happen. Although the nurses’ argument may have held some cultural truth, I’ve felt guilty about it ever since–and angry about a culture in which male genital mutilation has been a norm. I don’t know what the effect of circumcision has been on my son, but I’m pretty sure it hasn’t been good.

I’m very encouraged to read in this article that circumcision rates in the U.S. have declined from 90% to 57% in the past 40 years, and I’m hoping they’ll decline precipitously from now on! Here’s another area where we can learn from our wiser European, Canadian and Australian friends.